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So you just want to pass the Math section on the TEAS or the TEAS A5. How do you do that, if your math background isn’t that substantial. Well there is a way. Practice Practice and more practice. But where and what do you begin to study? At the Nurses Learning Center there are many tests that you can take online. You can choose from many different levels of math practice tests. All tests are online and you can choose to purchase one or more. Learn the steps to answer all of the math questions on the TEAS. Raise your scores so that you can get into the nursing school of your choice. Most nursing schools require a score of 80% on the TEAS or the TEAS A5. The math section is the one part of the exam that most students fail or score poorly. At the Nurses Learning Center students can feel confident that they are getting the correct study materials to pass the TEAS. What really helps students is that each questions has an explanation that goes through the entire problem, so that there is no question at how to arrive at the answer. Since students are not allowed to use a calculator on the test and they only have a short period of time to complete the math section, it is imperative that students can use their critical thinking skills.
The Nurses Learning Center helps students develop their math critical thinking skills by presenting the answer to each question step by step. Even students in school do not get as much help in their math classes. The Math 1 exam covers basic math skills such as adding, subtracting, decimals, long hand division and long hand multiplication. These skills are no longer taught in middle school and in high school. Yet those students seeking entrance into nursing school must do all the problems without calculators using long hand multiplication and division. Quite scary if you do not feel comfortable with these skills. Once you are a nurse you must use these skills to calculate medication dosages. Here a the Mynursingedu.com you can also purchase a hard copy book of the “Pass The NET”. It is the same as the online tests offered at nurseslearningcenter.com. Testing the TEAS can be very challenging. Students feel very intimidated by math. Some students will not go near a math test. Understanding math questions and knowing how to answer them will help students pass their math section. Knowledge is the key. Students should take their time studying for the TEAS. They should set aside time where it is quiet and they have the ability to concentrate. It is suggested that students take up to three months to prepare for the TEAS.
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Clinical practice guidelines for chronic Pain
The purpose of this paper is to identify the current clinical nursing guidelines regarding the treatment of chronic pain and its financial impact on the healthcare system, community, patients and their families. Additionally, this paper will explore the expectations of the BSN in the implementation and documentation of evidenced based practice.
Nursing management of chronic pain
Pain is a symptom that frequently goes unreported and unrecognized in patient care settings. Pain also has negative effects on the patient and their families.(Stenner, Carey, & Courtenay, 2012, p. 3335) “It’s disheartening for frontline nurses and other providers to feel they are not meeting their patients’ needs,” LaFevers said. “Not everyone can go to a pain specialist.”(“Better management needed,” 2014, para. 37)
Chronic pain and its significance in nursing practice
Chronic pain is an individual experience. Nurses face many challenges in helping those who suffer from chronic pain.(Dysvik & Furnes, 2012, p. 187) Pain is the main reason that patients seek healthcare.(Gretarsdottir & Gunnarsdottir, 2011, p. 16) Research shows that over 50% of these patients have suffered pain within 24 hours of seeking medical help.(Gretarsdottir & Gunnarsdottir, 2011, p. 16) An individual nurse may be able to help relieve the patient’s pain during their shift, whereas the next nurse on duty may not be able to provide the needed relief. Nurses working collectively as a team can better manage the effects of chronic pain in patients than a nurse acting alone. The management of pain as a group effort requires nurses’ to have a thorough knowledge of pain theory and the use of the behavioral and cognitive approach.(Dysvik & Furnes, 2012, p. 187)
The expectation of the BSN in chronic pain management
Belonging to a supportive team with clear roles helps in the complex management of chronic pain.(Dysvik & Furnes, 2012, p. 189) The BSN nurse typically assumes the leadership role.(Video Laureate Education, Inc., 2009) The group leader in the management of chronic pain is multifaceted.(Dysvik & Furnes, 2012, p. 189) The BSN must utilize the current research on the management of chronic pain and present this to the group. It is the moral and ethical duty of the BSN to utilize evidenced based practice.(Video Laureate Education, Inc., 2009) They are also the catalyst of change for their group.
Clinical practice guidelines in the management of chronic pain
According to the National Guideline Clearing House, chronic pain management should begin with assessment of the pain, the duration, intensity, description in the patient’s own words, location, onset, quality and duration.(Institute for clinical systems improvement [], 2013) The nurse should also take into consideration the psycho-social factors the chronic pain may influence, such as depression and drug abuse.(ICSI, 2013) The treatment of chronic pain is a mulifactorial group approach led by the physician and nurse leader.(ICSI, 2013) Treatment should be addressed in levels with medications not being the sole focus.(ICSI, 2013) Comprehensive patient assessment algorithms for chronic pain begin with addressing the psycho-social factors. These factors include the patient’s reaction to their pain, their scioeconic status, their support or lack of support system, family history of pain therapies and their cultural and ethnic beliefs on the management of pain. The nurses understanding of the biopsychosocial model helps with the implementation of a pain treatment protocol that will benefit the patient’s long term goals.(ICSI, 2013)
The impact of chronic pain on the patient and the community
The under treatment of pain is a global problem.(Gretarsdottir & Gunnarsdottir, 2011, p. 16) Unresolved treatment of pain can have negative impact on the quality of life, economic productivity and healthcare utilization.(Gretarsdottir & Gunnarsdottir, 2011, p. 16) In 2011 at least 100 million American adults have common chronic pain conditions.(“Relieving pain in America,” 2014, para. 12) Pain is a significant public health problem that costs society at least $560- $635 billion annually,( an amount equal to about $2000 dollars for everyone living in the U.S.).(“Relieving pain in America,” 2014, para. 12)
The cost of pain to the healthcare system
In 2008 the cost of pain to the federal and state government for medical expenditures was $99 billion dollars.(“Relieving pain in America,” 2014, para. 13) Analysis from the CDC showed that nearly half a million emergency department visits in 2009 were from people abusing or misusing prescription pain killers.(“Relieving pain in America,” 2014, para. 13)

Evidenced based practice as a change agent
nancy kimmel
November 4, 2014

Evidenced based practice as a change agent
Researching as a Team
Change begins with acknowledging a common problem and having the curiosity to research that problem in hopes of finding documented solutions(Schmidt & Brown, 2012). The BSN nurse is trained to be the agent of change(Video Laureate Education, Inc., 2009). The change agent should encourage nursing staff to participate in research regarding the problem at hand. This helps with building the teamwork ethic among staff. Assessing the literature requires a keen eye for gaps. Gaps, are what is known about a problem or if that problem has not been thoroughly tested(Schmidt & Brown, 2012, p. 69). Gaps also occur when there is only one or two case studies regarding a problem, insufficient information or lack of proven results(Schmidt & Brown, 2012, p. 69). For instance, a single study that only incorporates 50 test subjects, regardless of the strength of the statistical results is not sufficient evidence for evidenced based practice to be implemented. On the other hand, 20 or more similar case studies with strong statistical evidence to support the research question, would allow one to generalize the findings to a wider population(Schmidt & Brown, 2012, p. 69).
Practical Transition
Finding a solution to a problem as a group is a euphoric experience. However, taking that solution and putting into practice is a different matter. There are many pitfalls to the implementation of any new ideas or practice theories. Suppose the change that will take place requires a special device. This device costs money. The question is, will the hospital provide the financing for such equipment or supplies? All new protocol must be documented on the floors policy and procedure manual which utilization review must first approve. Hence, the red tape.
The Iowa Model for EBP (Evidenced Based Practice) is a systematic method for organizational change(Schmidt & Brown, 2012, p. 390) The Iowa Model diagrams the necessary steps to incorporate EBP in promoting better health care(Schmidt & Brown, 2012). The model provides a series of logical steps that assist the change agent in the decision making process.
Common Errors and Pitfalls
Not everyone is on the same page. The change agent should be sensitive to the fact that some nurses have no desire to engage in research, nor implement new care skills(Schmidt & Brown, 2012). Complex statistical evaluation and knowledge diffusion poses barriers to most practical nurses(Schmidt & Brown, 2012, p. 396). Change is a process that creates an alteration in a person or the environment(Schmidt & Brown, 2012, p. 397). While there is no exact answer how to implement change, theorists have suggested that preparation should be the first step(Schmidt & Brown, 2012). Beginning a journal club helps to engage others and encourages participation(Schmidt & Brown, 2012). The disciplined clinical inquiry model is helpful in structuring the journal club, by empowering nurses in clinical practice to consider the patient, clinical setting and resources(Schmidt & Brown, 2012, p. 399). Kotter’s eight change phases model is simple in design and begins with establishing a sense of urgency(Schmidt & Brown, 2012, p. 407).
Summary
While there is no one model fits all, the change agent should be aware of the important role they play in advocating change. Finding solutions to promoting better health care and positive patient outcomes is a responsibility of every nurse. Some nurses find that this is too much of a burden to bear in the context of their daily routines. Therefore the change agent needs to help with facilitating the process through preparation, empowerment of their staff nurses, encouragement and communication. Identification in the gaps of patient care is a team effort and all teams need a leader.

As a new nurse, I remember how frightened I was that someone would die do my lack of experience or a poor judgment call. I will never forget my one instructor who said, “You will make a medication error at some point in your nursing career.” That statement shook me to the core. How could that happen? During my orientation on the medical/surgical step down unit, I witnessed nurses nonchalantly switching out I.V. bags of different solutions without first checking the drugs compatibility. What if one of those medications causes a precipitate to form in the line? Then what? Someone could die of an embolism!
Soon I was on my own shift with my own patient load. The fears that plagued me during nursing school did not magically disappear, but instead became magnified. I was a nervous wreck. How did these other nurses manage their patient load with such grace under pressure? When would this ominous fear of doing something wrong let up? For me, it never did. The delicate balance between life and death based on a decision or action is what kept me sharp. Eventually I was able to display a calm exterior while internally; I was ready to react at the slightest change in my patient’s condition. There were no cutting corners. I know that sounds crazy. Obviously, when there were no washcloths we had to use towels, or sometimes we had to make do with what supplies were on the floor. Did I ever deliberately cut a corner just to save time? The answer is no. Everything that I do is for my patient. Even the smallest action of making a toe pleat in the bed or mitering a corner was a action of respect for the patient in that bed.
Nursing school prepared me with critical thinking skills. As my experience as nurse progressed, I became better at assessing a patient’s condition. I would not say that I became an expert according to Benner’s Stages of Critical Competence.(Benner, 2011, para. 5)
Making a competent clinical decision is not based on just one lab result or a patient’s symptoms. The personality traits of going above and beyond, taking risks and deliberate practice seem to be the traits that make an expert nurse.(Kaminski, 2010, p. 967)
Benner’s Stages(Benner, 2011, table 1) verified that I have much to learn. I am looking forward to learning more about evidenced based practice and the critical thinking skills necessary in advanced practice nursing.
Advanced Practice Nurses have the responsibility of providing and documenting research on evidenced based practice for the nursing profession as a whole. Nursing continues to develop and progress into a clinical science. This development is due to the efforts of those nurses who understand the dynamics of change in the role of the nurse in today’s society.

Great News;
Pass The N.E.T. has just been released in its second edition. This book continues to help student pass the HESI, HESI A2, TEAS and the N.E.T. Not only does this book have more questions and tutorials, but it includes additional sections on medical/surgical nursing practice questions, medication calculations, scholarship information and much much more.

All explanations are included with detailed solving methods to assist the student in taking the HESI, TEAS, or the N.E.T. quickly and proficiently.

Many students are not sufficiently prepared for the math section. They tend to take too much time on one problem. The methods that you will learn with this tutorial are similar to those that I teach my students to use. Analysis and critical thinking are some of the concepts that you will be able to apply when using this guide.

Those who are graduate nurses and those who are going into nursing school will soon be sitting for their national boards known as the NCLEX, or taking the N.E.T, the HESI or the TEAS. The state nursing board examinations are computerized and set up to test the candidate’s skill level. In order to pass the NCLEX. the candidate must demonstrate the level of skill required to practice the art of nursing safely in their state. In order to determine this level of skill, the NCLEX. is formatted to adapt to the testers knowledge base.

This type of computerized adaptation is termed, “computerized adaptive testing” or CAT. This type of testing is not new. It has been in use for many years. This is the method that the Graduate Entrance Exams (GRE.) have been using. To better understand how computerized adaptive testing works, think about taking a test where all of the questions are very easy. This type of test does not really test the ability of the tester that knows the material thoroughly. Therefore the tester’s true mastery of the subject is not assessed. Some of the nursing entrance tests are also test via computerized adaptive testing.

It is similar to being in class, where the teacher is asking questions. As the student answers the questions, the level of difficulty continues to increase, until the student reaches a point where they cannot answer a question, then the level of difficulty decreases, and the cycle begins again. This type of testing then does away with the redundancy of questions wherein the level of each is on a plateau, but rather poses questions that challenges the tester’s ability to the point that their true ability of their mastery of the subject matter can be assessed.

Therefore, those student’s, sitting for the NCLEX who are answering easier questions, may find themselves answering more questions than those students who are able to answer the harder questions and thereby have fewer questions. One could say that computerized adaptive testing is geared to each individuals own knowledge base. After each question the tester is scored. Each following question will be chosen to match their skill based on how they answered the previous question. There is a statistical program built into the main program that estimates the tester’s knowledge proficiency. There is a pre-set statistical data base that dictates the percentage of questions that are needed for a graduate nurse to pass or to fail.

“The CAT usually ends when the amount of measurement error around the ability estimate reaches an acceptable level. Low levels of measurement error are required for high-stakes certification tests and indicate that the test would likely produce a similar score if re-administered immediately afterwards. It is not known exactly when the test will shut off or how many questions have to be completed. The computerized adaptive testing usually presents a variable number of questions, and a minimum and maximum number is pre-set.”

Therefore, if the graduate nurse answers incorrectly the easy questions, as well as the more difficult questions, they will be less likely to sit for the entire six hours and their test may shut off after the minimum of seventy five questions. It is the seventy five questions that many graduate nurses are fearful of receiving, because they think that they have failed the NCLEX. If the tester has a good solid knowledge base and has prepared for the test by practicing NCLEX questions, then the seventy five questions shut off is actually a good sign. The score is based upon the level of difficulty that is achieved. This is the methodology that the NCLEX uses to test the nursing school graduates.

The HESI, The N.E.T. and The T.E.A.S. will shut off at a specific length of time, which is usually a 3 hour test. So not all of the questions that one student has, will the other student have. The most important preparation is to begin studying soon and to begin with the right materials that will help you to pass. You can begin to study for your Nurse Entrance Test at the Nurses Learning Center, where you can get immediate access to over 1000 questions and answers, tests are available 24 hours, 7 seven days per week, and you only have to pay a one time fee. This material is set up just like the HESI, The N.E.T. and The TEAS.

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